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, r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> rn <br /> JOB ADDRESS 450 Commerce Court CITY/ZIP Manteca,California m <br /> D <br /> CROSS STREET APN I PARCEL SIZE 1 YLAND USE APPLICATION# z <br /> OWNER NAME Ebma Investments c/o LDA Partners PHONE 209-943-0405 y <br /> OWNER ADDRESS 222 Central Court ITY/STATE/ZIP Stockton,California <br /> CONTRACTOR <br /> Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATE/TJP Clovis,California 93612 <br /> SUBCONTRACTOR <br /> Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATE/LP Clovis,Califomia 93612 <br /> LICENSE /C-57 C-61 l 0-09 i Other NUMBER `1479906 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)F-Arsenic(4393) <br /> INTENDED USE D Domestic/Private Irrigation/Agricullurat Industrial -Water Quality Monitoring Soil Sampling/Characterization <br /> E Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK D New Well Replacement Well E Well Alteration/Modification E Other <br /> E Monitoring Well(s) #of wells E Soil Boring(s) Ii b0fi"9' f Geotechnical 4 #of borings <br /> j Out-Of-Service Well ❑Out-Of-Service Well Renewal Ll Cross-Connection Repair (10-50 Feet) <br /> ❑New Pump ❑Pump Replacement Cl Pump Repair E Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary f7 Air Rotary //Auger Cable Tool Push Point Other <br /> Proposed Well Depth ft Excavation in diameter 7,Open Bottom Gravel Pack/Gravel Size in diameter <br /> L=Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched [I Steel a Plastic Stainless Steel Other <br /> Grout Seal Depth ft �/Neal Cement(94 Ib bag/5-10 gal water) E Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method i Pumped E Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By !Driller n Pump Contractor IOther <br /> , Concrete Pedestal Li Dimensions:Width ft Length ft Thick n Christy Box Stove Pipe <br /> PUMP ISubmersible7:Turbine Other HP Pump Set it Standing Water Level ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> "=M 48 H AD E NOTICE R QUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED <br /> - <br /> TITLE <br /> Managing Engineer DATE 12/18/2019 <br /> �4 <br /> �'I A�-V <br /> H y c <br /> pqROU <br /> 4�Y <br /> T <br /> ------------- <br /> D,WPARfrMENT USE OLY <br /> Application Accepted By Mate Area mployee ID#�<�t" <br /> Grout Inspection By r r' Date �� I "� SPECIAL Well Permit <br /> Pump Inspection By Date I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE F SC ReceivedChec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info By_ emitted Service Request# <br /> 2 O 2. W Poo 4 <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />